1. Field of the Invention
The present invention relates to an apparatus for manipulating body tissue during surgical operations and, more specifically, to an apparatus for manipulating the uterus for examination of the uterine cavity and other surgical procedures and for allowing the introduction of dyes or marker substances.
2. Description of the Prior Art
Laparoscopic and endoscopic surgery has been widely accepted as the preferred surgical procedure for treatment of a variety of disorders that were formally treated by conventional surgical techniques. In laparoscopic procedures, surgery is performed in the interior of the abdomen through a small incision; in endoscopic procedures, surgery is performed in any hollow viscous of the body through narrow endoscopic tubes inserted through small entrance wounds in the skin.
In conjunction with laparoscopic surgery, pneumoperitoneum gases are generally introduced into the peritoneal cavity to expand the cavity and raise the cavity wall away from the vital organs therein. Thereafter, a trocar, which is a sharp pointed instrument, is inserted into a cannula assembly and used to puncture the inner lining of the peritoneal cavity. The trocar is withdrawn and a laparoscopic surgical instrument is inserted through the cannula to perform the desired surgery.
Current operative procedures involving the uterus, include, for example, examination of the uterus for the purpose of sterilization, investigating tubal patency in cases of infertility or laparoscopically assisted vaginal hysterectomy procedures. In such techniques, it is often necessary to manipulate or reposition the uterus in order to gain visual and tactile access to different areas of the uterus and the surrounding organs. In particular, in laparoscopic assisted vaginal hysterectomy, the uterus needs to be manipulated to provide sufficient access to sever it. That is, the uterus is manipulated to properly position an instrument inserted through a trocar cannula. It other procedures such as determining the patency of fallopian tubes, it is desirable to insert dyes or marker substances intravaginally.
Prior art devices for manipulating or repositioning the uterus include uterine grasping forceps which enable the surgeon to firmly grasp the uterus and manipulate it to a desired position. However, due to the narrow configuration of the forceps jaws, such manipulation can result in injury to the uterus including penetration of the uterine wall or tearing surrounding tissue.
Another type of uterine manipulator device includes a catheter having an inflatable or hollow balloon member at a distal end thereof. The catheter is introduced thru the cervix and the balloon is inflated within the uterus to engage the uterine wall to position the uterus for examination purposes and for manipulating the uterus. Although the devices incorporating inflatable balloons have proven to be less invasive than the aforementioned conventional forceps devices, these devices have their own particular shortcomings. For example, the prior art balloon devices known heretofore fail to provide a mechanism which enables the surgeon to readily and incrementally control the level of inflation of the balloon.
Another type of uterine device is disclosed in U.S. Pat. No. 5,217,466 to Hasson. This device has a bendable distal end controlled by a ratchet mechanism to define a guideway into the fallopian tube. A spring biased seal member is provided.
The need exists for an apparatus which obviates the inherent disadvantages of known uterine manipulators by providing a minimally obtrusive manipulating instrument which can effectively manipulate the uterus, allow the injection of substances into the uterine cavity, as well as accommodate various size patients.